both directions back to back 6 months
Rolls
peek a boo, patty cake, and (cruise) walks by holding onto furniture by 9
months
Plays
at 2 understood by family
Speech
at 3 understood by strangers
Speech
tricycle at 3, bicycle at 6
Ride
Copy a circle
3-year-old
can copy a cross
4-year-old
child expresses to marry parent of opposite sex
Oedipal stage 3-6
Draw stick person with 3 body parts
4 years old
Draw tick person with 6 body parts
5 years old
painful abdominal (retroperitoneal or hepatic) mass that is fixed firm or irregular and frequently crosses the midline, common site is the adrenal medulla,
Neuroblastoma
patient present with Metz disease, weight loss fever, Horner’s syndrome ( miosis, ptosis, anhidrosis) racoon eye, bone pain, HYN, diagnosed in children 1 to 4, elevated urinary catecholamines and anemia,
Neuroblastoma s/s
US of the abdomen, refer to nephrologist
Neuroblastoma Dx
renal malignancy, crosses midline congenital tumor of kidneys, common in African American girls,
Wilms tumor (Nephroblastoma)
asymptomatic abdominal mass extends from the flank toward midline, nontender smooth mass abdominal pain, hematuria, HTN, 2-3 years old, palpate with rupturing mass
Dx - US abdomen
Wilms tumor s/s
acute and rapid onset of high fever chills and toxicity, sever sore throat, drooling, not eat to drink, hot potato voice and anxiety, sitting posture with hyper extended neck, open mouth breathing stridor, tachypnea/cardia, 2 to 6 years old,
Dx - prophylaxis rifampin, reportable disease call 911 rare due to Hib vaccine
Epiglottis
common in infants/children- infected bone or joint is red swollen, warm and tender to touch, febrile and irritable, walks with limp, infection in hip, knee or leg, results in growth stunting of the affected limb,
Tx - refer to hospitalization for high dose Abx
Osteomyelitis
abrupt onset of deep eye pain high fever, chills, aggravated by eye movements, bulging eye, abnormal extraocular exam movements due to infection of the ocular fat pads and muscles. Ethmoid sinusitis is cause, can be life threatening, serious complication of rhinosinusitis, acute otitis media, or dental infections
Tx - refer to ER CT or MRI scan in ED
Orbital cellulitis
infection of anterior portion of the eyelid does not involve orbit or globe of eye, rarely causes complications, red swollen eye pain, eye movements are normal
Tx - refer to ED
Pretectal cellulitis (periorbital cellulitis)
Child abuse - PDR
Death 1 to 4 - AUCA
Cancer in children - LBN
ready by 2, mastered by 3 to 4, abnormal if not done by 5
Toilet training
40 lbs. can sit facing forward
Car safety